Florida Society of Pathologists
The Florida Society of Pathologists (FSP) is the voice for all pathologists working in the frequently intense field of pathological medicine. FSP not only monitors legislation affecting the ability of physicians to work in our hospital and laboratory environments, but works closely with, and is officially recognized as a state specialty organization of the Florida Medical Association and the College of American Pathologists.
FSP consistently produces quality CME medical meetings offering National and International featured speakers and an excellent opportunity for our colleagues to meet formally and informally to discuss the present and anticipate future challenges of our profession.
The Florida Society of Pathologists is your organization.
The Florida Society of Pathologists:
- Represents the interests of patients, the public and pathologists by promoting excellence in pathology services in the State of Florida.
- Educates members concerning the latest scientific developments in Pathology
- Promotes State and National legislative initiatives that will encourage excellence in pathology services and protect medical services for the public in the State of Florida.
- Promotes collegially and communication among members.
- Educates patients, the public and legislative officials concerning the importance of pathology services in the practice of medicine.
- Stimulates communication and cooperation with other State, National and International organizations.
- Promotes scientific investigation among pathology residents.
FSP President’s Message:
The first 7 months of my two year term as your Florida Society of Pathologists president have quickly passed with plenty of activities. Here is a brief summary of our current efforts:
- Your FSP has continued discussions with the CAP, United Beacon, and with representative of the Texas Society of Pathologists concerning the Laboratory Management Plan implemented by United Beacon in Florida as a pilot on April 1.
- Our local CAC (Medicare Carrier Advisory Committee) meeting with First Coast Service Options was attended with considerable thought and research on the response to the proposed Local Carrier Determination (LCD) that included many anatomic pathology proposals, including special stains and IHC. FSP then sent a subsequent comment letter to First Coast. Many thanks to all of you who responded to the FSP Call to Action to send comments.
- Pathologists and FSP were also well represented at the FMA annual meeting in Orlando the end of July.
Our Summer FSP Conference in July was a great success with outstanding and very practical speakers in a wonderful venue at the Boca Raton Beach Resort and Spa. Dr. Andrew Rosenberg , Dr. William Westra, and Dr. Cesar Moran gave engaging lectures covering very timely topics important in general pathology practices. As always, the collegial interactions are a real attraction as well. For those of you who that missed the event, please keep your eyes out for next summer's meeting information in the near future.
We are finalizing all the details for our nationally recognized Winter meeting, next year, Feb 12-14, 2016 again by popular demand at the Disney Contemporary Resort in Orlando. Look for registration information coming out soon, and remember to book your hotel early if possible to assure a room in the Contemporary.
FSP offers broad benefits to our members. We are THE pathology dedicated voice representing our professional interests in our great state of Florida. We employ a long term and very experienced lobbyist, Amy Young, with Ballard Partners (named the #1 Small Lobbying Firm in Tallahassee in 2015) who keeps us informed of statewide developments throughout the year and represents our interests in Tallahassee with support of your Board. We have an active Political Action Committee, using those resources to continue access to our representatives and senators. We actively represent your interests at FMA, CAP HOD, and our CAC. We have bimonthly newsletters with society and national news as well as highlights of important publications. Important state legislative issues are highlighted on our website. We offer two outstanding educational conferences a year, each February in Disney, and at the coast in the summer. We bring in really great and nationally recognized speakers to both these meetings, offer SAM's, pay member registration for the CME's through CE Broker, and have legislative updates. All this in beautiful and fun venues where there are plenty of opportunities to see friends and colleagues.
As we know, times in medicine are changing dramatically. The name of the game to be at the table, not on the table. THAT TAKES INVOLVEMENT AND NUMBERS SPEAK LOUDEST.
It is time to spread the word, increase our support and recognition as pathologists, and increase our influence. Each and every pathologist in our state should be an FSP member and PAC supporter to support your profession, to be involved, and to be heard. Please check to assure your membership status is current – our new year has begun. Talk to others about the importance of supporting your professional society and the advantages of membership.
BE INVOLVED. JOIN AND RENEW YOUR FSP MEMBERSHIP TODAY.
I thank you for the opportunity to represent the pathologists in our state and to work closely with your outstanding and dedicated FSP Board members as we continue to advocate for pathologists' interests.
Margaret Neal, MD, FCAP
President, Florida Society of Pathologists
KWB Pathology Associates, Tallahassee, FL
We only have seen a few agendas for next week (only those published for Monday February 1st), but we do know that on Monday the Senate Health Policy Committee is slated to take up bills that deal with "direct primary care" agreements, certificates of need, "balanced billing" and Senator Gaetz extremely important legislation (SB 1084) dealing with a "Beacon fix". (Unfortunately, the companion bill to 1084, HB 963, has not yet gotten a hearing in the House but we are working very hard to change that!!)
This agenda is extremely important and we have many physicians already lined up to speak on all of these issues on Monday.
The direct primary-care issue (SB 132), sponsored by Sen. Denise Grimsley, R-Sebring, is the least controversial and has gone through all the committees in the House and is now ready for a House floor vote perhaps as early as next week.
This is good legislation for those of you who prefer to operate on a concierge level and don't want to file insurance paperwork and want an arrangement with your patients that generally involves patients making monthly payments for primary care services.
Although this legislation does not impact pathology directly it is a good precedent for future legislation and would effectively reduce the role of insurers in patient services.
House Republican leaders also have pushed to eliminate the certificate-of-need regulatory process for hospitals. That process, in part, requires hospitals to get state approval for construction and expansion projects. But the Senate Health Policy Committee will take up a bill (SB 1144) on Monday, filed by Sen. Don Gaetz, R-Niceville, that differs significantly from the House approach. Gaetz's bill would allow exemptions to the CON process but would condition them on health facilities meeting criteria for providing care to low-income people.
The Health Policy Committee also will consider balance billing legislation (SB 1442), sponsored by Sen. Rene Garcia, R-Hialeah, that would seek to shield patients from receiving unexpected bills for emergency care. We are not supporting the balance billing legislation in it's current (House or Senate) form but working hard with the sponsors to have a reasonable UCR reimbursement if balance billing is prohibited. I expect the House version of the bill to be taken up in it's 2nd committee of reference next Wednesday. This issue, of course, is of HIGH PRIORITY for pathology and we have been working hard to ensure that we will have a reasonable reimbursement based on pathology CHARGES if this legislation passes.
Amy J. Young, Managing Partner
FSP Legislative Consultant
'BALANCE BILLING' PROPOSAL CLEARS HOUSE PANEL
In an issue watched closely by doctors, hospitals and insurers, a House panel Tuesday approved a proposal aimed at protecting patients from surprise charges when they need emergency care. The bill (HB 221), approved by the House Insurance & Banking Subcommittee, deals with an issue known as "balance billing." That can occur, for example, when patients need emergency care and are treated by doctors who are not part of the networks of the patients' insurers. In such cases, patients can get billed for differences between what their insurers pay and additional amounts that are charged. The bill would make insurers responsible for paying for emergency services and would include an arbitration process to resolve differences between insurers and health-care providers. The Florida Association of Health Plans, which represents insurers, supports the proposal. But physician and hospital groups raised concerns about the bill, in part because of a provision that says insurers could pay a "reasonable reimbursement" for care. Steve Ecenia, an attorney for the HCA hospital chain, said the problem is determining what a "reasonable" charge would be. Ecenia and some lawmakers said a solution might be to make clear patients aren't responsible for extra charges and then let insurers and providers resolve billing disputes on their own. "The consumer has to be protected,'' Insurance & Banking Chairman John Wood, R-Winter Haven, said. "There's no dispute about that."
This will be one of the hottest issues in the 2016 Session:
The Florida Office of Insurance Regulation will support efforts to limit what physicians can charge insured patients who seek emergency medical care from out-of-network providers, reports Christine Sexton of Politico.
The OIR made the announcement at a Cabinet meeting Wednesday, when insurance commissioner Kevin McCarty’s chief of staff, Belinda Miller, outlined the agency's legislative agenda for the upcoming 2016 session.
The so-called “balance billing ban” has been one of the most divisive health insurance issues over the last several years and pits the state’s largest medical organization against the insurance industry.
Balance billing for emergency services already is prohibited for HMO patients but there is not a similar prohibition for patients insured in traditional health plans.
Fall 2015 Updates:
FIRST COAST SERVICE OPTIONS
As you know, First Coast Service Options, Inc., (First Coast) is the Medicare Administrative Contractor for jurisdiction N, serving Medicare providers and beneficiaries in Florida, Puerto Rico, and the U.S. Virgin Islands. The Provider Outreach and Education department has been working to promote Electronic Remittance Advice (ERA) to those providers still receiving paper remittances through regular mail. We have been performing focused education by reaching out to those providers that we show still receiving paper remittances and offering education and assistance. With this email, we are continuing our efforts on educating providers about ERA.
Click here for a flyer about the benefits of ERA. This flyer provides additional information about ERA, including free software and additional resources. There are numerous benefits to the use of ERA and it is First Coast’s endeavor to assist providers in this transition so that they may reap the entire benefits of moving forward with technology.
Key billing information from the FAQs follow:
Q21. What should I do if I receive a laboratory specimen for testing, but the physician did not complete advance notification?
A. Please perform testing as you normally do and contact the physician to complete the advance notification process. Advance notification must be completed within 10 calendar days from the date of service and prior to the claim being submitted. If advance notification is not completed, your claims for the test may be denied.
Network care providers cannot balance bill the member for covered services, per the terms of their contract with UnitedHealthcare.
Q28. Will UnitedHealthcare reimburse providers for secondary pathology review?
A. To determine reimbursement policies, UnitedHealthcare applies industry standards from third parties including the American Medical Association (AMA) and CMS. You can view
Insurance coverage provided by UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc., its affiliates or designees.
UnitedHealthcare Commercial reimbursement policies on UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Reimbursement Policies – Commercial.
Please note that we do not provide examples of billing practices, but we accept all standards of billing highlighted under AMA standards and CMS requirements. There are two ways to bill for secondary pathology review.
1. Use the pathology consultation CPT codes developed by the AMA:
- 80500: Clinical pathology consultation; limited, without review of patient's history and medical records
- 80502: Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient's history and medical records
Per the UnitedHealthcare Laboratory Services Policy, CPT codes 80500 and 80502 are only reimbursable for reference laboratories or for providers whose primary specialty is pathology or dermatology. UnitedHealthcare considers clinical and surgical pathology consultation codes as included in an evaluation and management service if provided for the same member on the same date of service. If billed with an evaluation and management service, CPT codes 80500-80502 and 88321-88325 are not separately reimbursable. For more information, please review the policy at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Reimbursement Policies – Commercial > Laboratory Services Policy.
2. Append the correct modifier to the surgical pathology CPT codes.
Per the UnitedHealthcare Laboratory Services Policy, surgical pathology CPT codes 88300- 88309 describe gross and microscopic examination and pathologic diagnosis of a specimen. Two or more specimens separately identified from the same patient are each assigned an individual code to indicate the level of service. Under certain circumstances, the physician may need to report the same surgical pathology code for multiple specimens for the same patient on the same date of service. Pathology specimens from the same anatomic site reported with the same surgical pathology CPT code may be reported on one line with multiple units. For more information, please review the policy at UnitedHealthcareOnline.com > Tools & Resources > Policies, Protocols and Guides > Reimbursement Policies – Commercial > Laboratory Services Policy.
Comments have been submitted to the First Coast Service Options on behalf of Florida Pathologists. Click Here to read the letter.